Geopolitics and Health Equity: A Complex Interplay
Sandhya Venkateswaran explores opportunities for advancing health equity through strategic cooperation and diplomacy.
A pandemic agreement, laying out principles of governance to tackle future health emergencies was recently adopted at the World Health Assembly on May 20, endorsed by 124 countries. The result of three years of negotiation, the agreement aims at strengthening global cooperation in pandemic preparedness and response through equitable distribution of vaccines, diagnostics, and treatments. The endorsement of 124 member countries on envisioning a pathway to preventing and managing global disease outbreaks is no small achievement, and the outcome needs to be commended.
Yet, the history of global governance has shown, time and again, that the mere development of agreements is not sufficient in the absence of strong compliance and enforcement mechanisms. The recent pandemic is a case in point, when despite mechanisms such as COVAX, richer countries disproportionately accessed vaccine supplies through advanced purchase agreements, undermining the achievement of health equity across countries. Global governance platforms and institutions have come under considerable criticism for their inability to address emerging health challenges. A combination of fragmented global governance structures and nationalistic policies is leading to inequities in the distribution of health resources. On the one hand health cooperation is becoming more critical in a deeply interconnected world, while at the same time, trust in global structures is becoming weaker.
Health equity across countries is becoming more complex and interdependent due to geopolitical shifts, supply chain disruptions, epidemiological shifts and health being viewed as a security concern. All these are contributing to make collaboration and decision-making more complex.
In today’s complex globalized world, while geopolitical forces can exacerbate health disparities through conflict, economic power imbalances, and unequal resource distribution, they also offer potential avenues for international cooperation and solidarity. To achieve global health equity, it is essential to recognize and strategically navigate the geopolitical determinants of health.
There are many ways in which geopolitics is influencing global governance and its ability to achieve global health equity. One, the world today has a growing number of health actors, often with conflicting priorities and weak (if any) enforcement mechanisms, all of which dilute the effectiveness of multilateral and other global efforts. The Pandemic Agreement for example, is legally binding, emphasises transparency and accountability but in the absence of WHO having authority to enforce compliance with the treaty's provisions, its effective implementation depends on voluntary cooperation. Two, geopolitics can hinder or promote health cooperation, such as vaccines becoming diplomatic tools, as seen between Lithuania and Bangladesh or China using medical goods trade to expand its influence in the Global South, particularly in Africa. Three, diplomatic standoffs can undermine the effectiveness of global frameworks and agreements, and it remains to be seen how the withdrawal of the Unites States will impact the Pandemic Treaty in achieving its goals, with the US advocating for an alternative global health framework. Four, conflict and political unrest disrupt essential services and destroy health infrastructure (conflicts in Syria, Ukraine and other countries have destroyed healthcare systems, and left many with no access to medical care). Five, sanctions undermine country ability to build health resources, with shortages impacting the vulnerable population disproportionately. Six, climate change, a threat to health equity, is disproportionately affecting low-income countries that are least responsible for global emissions. Seven, global trade policies and the role of pharmaceutical lobbies, limit access to affordable medicines.
Most of these challenges are not new. As far back as 2010, David Fidler highlighted the flaws in global health governance, the inability to prevent health problems from becoming global crises and failures to implement key treaties. These are a larger concern now, with the added challenges of climate change, emerging epidemiological threats, and demographic shifts.
Geopolitics has its challenges but can also offer opportunities for advancing health equity through strategic cooperation and diplomacy, the latter encouraging countries to collaborate on health issues. These could include joint disease surveillance initiatives, data sharing and coordinated responses to health emergencies, and cross-border healthcare access programs, as part of health diplomacy. Regional institutions such as the African Union and ASEAN could focus more strongly on data sharing, epidemic preparedness, and procurement mechanisms. The African Union has already played a key role in coordinating health responses across the continent. Regional cooperation could contribute to offsetting global power asymmetries and amplifying the voices of LMICs in global health governance. The Global South can reshape global health governance, with India, Brazil, and South Africa already leading South-South cooperation and promoting context-specific institutions and norms. Stronger voices from the global south in the deliberations of global governance mechanisms and establishing principles of adherence will better reflect their needs and ensure equitable distribution of health resources.
The adoption of the pandemic agreement is undoubtedly a significant step towards global health equity. Its success however, like many other global agreements, will depend on whether countries will adhere to its principles without binding enforcement mechanisms.
Sandhya Venkateswaran focuses on health policy issues and is Commissioner, Lancet Citizen’s Commission for Reimagining India’s Health System. Views are personal.
Photo by Anna Shvets
